Post-Biopsy Prophylaxis Caution Urged
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The researchers retrospectively reviewed all gram-negative bacteremias diagnosed in their community hospital from January 2005 through March 2006 in men aged 45-90 years. They also collected data on bacteremic patients who had recently undergone TRUS prostate biopsy.
Of 89 cases of gram-negative bacteremias diagnosed in older men during the study period, 13 (14.6%) were preceded by TRUS prostate biopsy. The mean age of the patients who were diagnosed with gram-negative bacteremias was 61 years (range 52-76 years). All 13 patients received prophylactic antibiotics before and after the TRUS biopsy. FQ were given to 11 of the 13 patients; two received trimethoprim-sulfamethoxazole because they had FQ allergies.
All 13 patients had E. coli bacteremia. In 12 (92%), the infection was resistant to FQ, including 11 of the patients who received FQ prophylaxis and seven (54%) who were resistant to trimethoprim-sulfamethoxazole. Additionally, the investigators found gentamicin resistance in 38% of the isolates.
The time between the biopsy and the date of the first positive blood culture ranged from 1-7 days, with a mean interval of three days. Of the 13 men, 11 required hospitalization. Although no deaths occurred, severe sepsis developed in two and an epidural abscess developed in one.
“It is not just the prophylaxis in this setting that is causing the resistance, but the overall overuse of quinolones for treating many infections, including pneumonias,” Dr. El Koussaimi told Renal & Urology News. “We are not sure what urologists should use but they may want to consider using another antibiotic because the prophylaxis strategy may need to be changed.”